Why Do Doctors Know So Little About Sex?

When it comes to, well, coming, they're really no help.

About forty percent of my clients are males who experience problems relating to sexual dysfunction. Some issues they deal with are premature ejaculation, losing or sustaining their erections or having difficulties ejaculating.

Many turn to their GPs, but while going to the doctor is straightforward if you have stomach pains, seeking help with sexual problems is very embarrassing for most. It's therefore disappointing to hear that many of my clients feel their doctor was not helpful or found it difficult to talk about sexual issues themselves.

If you are a GP and a young man comes to see you complaining about often losing his erection, the first question I would ask is: does it also happen when you self-stimulate? If the answer is no, he may have acquired performance anxiety.

Loss of erection only has to happen a few times for a man to feel doubt, leading to anxiety the next time. When he starts anticipating problems about his performance, it becomes a self-fulfilling fear. Just prescribing young men Viagra or Cialis is not helpful -- only men over 50 may need them.

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To keep an erection a man must be sexually aroused. When his anxiety takes over, it inhibits the blood flow in the penis, which can result in erection difficulties. The same effect happens when a man has difficulty ejaculating or not be able to ejaculate at all -- he concentrates so much on reaching orgasm that he is not sexually aroused anymore.

Premature ejaculation, PE (coming too quickly), affects about 30 per cent of the male population. These men can easily be taught how to last longer with the right psychosexual education. When a young man has sex for the first time and comes too quickly, which can be extremely embarrassing, he soon will become anxious and worried, and the cycle will start.

It's quite common these days for GPs to prescribe healthy young men a class of antidepressants, called selective serotonin reuptake inhibitors (SSRIs), because it's known they can delay ejaculation. Instead, they should look at referring those men for sex-therapy counselling first. What about the side effects of taking daily anti-depressants when they may have acquired performance anxiety that can be treated effectively. It's also important to remember that the average vaginal ejaculation time is between three and seven minutes. Some men believe they have PE because they only last 10 minutes!

Last month I saw a 28 year old client who never had erection problems until he met a woman who he really fancied and was very upset when he lost his erection when they tried to have sex the first time.

Unfortunately she wasn’t very understanding and his anxiety was instant, he tried Viagra which didn’t help and he stopped seeing her. Ever since this incident he also had difficulties with other partners. I explained he had acquired performance anxiety and helped him understand the issues that caused his anxiety. We discussed how to reduce them and provided him with advice, tips and techniques how to overcome them.

Another sexual problem that many doctors don’t seem to know about is vaginismus -- a condition that can cause great distress to women and their partners. Women who suffer from vaginismus are unable to have sexual intercourse or, if they try, it's very painful. The condition is caused by the involuntary contraction of muscles around the entrance of the vagina. This article explains vaginismus in detail and the sad fact is that these women are too often misdiagnosed by their GPs and even by some gynaecologists.

Another hot topic for women is hormone replacement (HRT) which was the standard treatment for women with menopausal symptoms like hot flushes, night sweats, vaginal dryness and loss of sex drive.

In 2002 a large study in the USA showed that women taking HRT showed a higher than normal rate of breast cancer and heart disease. This alarming study scared millions of women and their doctors away from using HRT. But 10 years later researchers found that the findings were flawed and that hormone replacement therapy is not as risky as once believed. But there is still confusion amongst women and medical professionals about the best treatment.

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Meanwhile, testosterone therapy is being researched as a potential treatment for the loss of sex drive for some women, and for several years a HRT drug called Tibolone​, which acts like a combination of all three sex hormones (oestrogen, progesterone and testosterone) is on the market. One of the many benefits of this medication may be prevention of osteoporosis. It's therefore important that GPs should not talk women out of taking HRT but should explain the risks and benefits, and provide an informed choice instead.